Viewers often get biased information, unbalanced evaluations of a procedure’s risks and benefits, and narrators with unclear qualifications, the study authors report in JAMA Facial and Plastic Surgery.

“When talking to my patients about (nose surgery), for instance, they’ll tell me what they know based on online videos, and oftentimes it’s not really what I do for a procedure,” said senior author Dr. Boris Paskhover of Rutgers New Jersey Medical School in Newark, in a phone interview.

“The information isn’t patient-specific and it doesn’t focus on the risks of a procedure,” he said. “Many videos only focus on how the nose will look, and they’re often superficial.”

Paskhover and colleagues evaluated the top 240 videos related to plastic facial surgery on YouTube, including blepharoplasty (eyelid surgery), dermal fillers, facial fillers, otoplasty (ear surgery), rhytidectomy (a facelift), lip augmentation, lip fillers, and rhinoplasty (nose surgery). For each video, the researchers determined the board certification status of narrators by using the American Board of Medical Specialties database. They classified the videos as created by a health professional, patient or third party.

They also evaluated each video using the DISCERN criteria, which rates consumer health information based on whether it’s clear, relevant, sourced, balanced, unbiased, describes risks and benefits, explains areas of uncertainty, and provides additional information sources. On a 1-5 scale, low scores indicate a low overall video quality. Overall, the videos had an average score of 2.21.

Among the videos, the research team found the term “nose job” received the most views with more than 56 million views for the top 10 videos and an average of 2.8 million views per video. Nose surgery videos had a DISCERN ranking of 2.1 overall.

Blepharoplasty, or eyelid surgery, videos had the highest quality rating at 2.75, followed by the search term “facelift,” with a score of 2.4.

“I tell my patients that 50 percent of what’s online - YouTube or otherwise - is wrong, and 49 percent is correct but completely irrelevant to your particular situation,” said Dr. Philip Miller of Gotham Plastic Surgery in New York City. Miller, who wasn’t involved with this study, creates online videos for patients but also recommends talking to a doctor about the specifics of a procedure.

“By all means, educate yourself, but what’s on your monitor shouldn’t take on the power of authority,” he told Reuters Health by phone. “When it comes down to it, have a great relationship with your doctor and let your doctor guide your care.”

Patients should know the weaknesses of videos in other medical specialties, too. In a 2017 study, researchers found that YouTube videos about brachytherapy, a radiation oncology procedure used to treat cancer, often had a strong commercial bias.

“As is common with many procedures in medicine, sometimes it is easiest to see a video of how the procedure is carried out rather than reading a pamphlet or a consent form,” said Dr. Arpan Prabhu of the University of Pittsburgh Medical Center in Pennsylvania. Prabhu, who wasn’t involved with this study, was the lead author on the brachytherapy study.

“There’s a significant need for quality videos to be created and uploaded,” he told Reuters Health by email. “We hope to be part of the solution in the future.”

In the facial plastic surgery study, researchers saw a difference between the scores of videos with medical professionals versus those without.

Overall, however, most videos didn’t include information verified by medical professionals.

“Online health-related information is for the most part unregulated, and consumers should bear this in mind and think about the source of the material they are viewing or reading,” said Dr. Trevor Kwok of the University of New South Wales in Sydney, Australia.

Kwok, who wasn’t involved with this study, has evaluated YouTube videos about varicose vein treatments.

“This is no longer an ‘emerging’ issue as the web and social media are already so ingrained in daily life,” Kwok said by email. “But our understanding of exactly how this affects healthcare consumers is lagging.”